HomeMy WebLinkAboutMortgage_Satterfield (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C¢unThip Year
•- FOR DEDUCTION FROM ASSESSED VALUATION 1p�1,
�'- State Form 43709(R13/10-15)
Prescribed by Department of Local Govemment Finance
INSTRUCTIONS: File Waled To be filed in person or by mail DEC 3 0 Fbl aled with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the props s County Auditor
located on or before January 5 of the immediately succeeding calendar year (
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Audit&kRSe pp NnlT`/ AUDITOR
County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought,'
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see ' ' on reverse see)
Drstxt Key number egal description Record number Page number
. 4— --a 01-6- 1 —ri—►—LI.U{— On I a— a,- _K aDIto `la-ice.
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessmentQ5-31i a� ce ment year` date of application legal or equitable owner?
.! b0V neaS ❑ No
If no.what is his I her exact share of Interest? If owned with someone other than spouse,MO- with whom
If name on record is different than that of applicant,indicate below: / question:Annually Assessed
• ❑ Annually Assessed
�-1.;� _ Mobile Home(IC 6-1.1-7)
Na a of mortgagee or contact seller 1
Na r 3�C� Sri\ .f1.•••••
Address of mortgagee or contract seller(number and street,city,state,and ZIP I •••• •
.•
Name of assignee or other comer or holder of mortgage ,JAS Ct •• ••••••• -
Address of assignee(number and street city,state,and ZIP code) Gar s-.0
Does applicant own property in any If yes,what county? What Taxing G .orris deduction been requested ' If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes o I anent yeaR . ❑Yes ❑No
A person is not entitled to • deduction unless the person has a balance on me person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 _ 20 20 20
Signature of County Auditor County • Date(month,day,year)
•
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Sig - re(ovine full name) Date(month,day,year)
• / ilk 1920.1 to
i r t:••• of a number arc street state,and ZIP code)
AP L cx>lceivn , IN y -10-10
Person authorized by duly executed Power of Atromey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.